NUR 231
Maternal Nursing
Exam 4 2026\2027
update
Seventy NCLEX-style questions covering
labor and birth, obstetric emergencies, the
postpartum period, and newborn adaptation —
each with the correct answer and a detailed
rationale explaining every distractor.
Galen Maternal-Newborn Nursing Curriculum
Alignment
70 QUESTIONS · ANSWERS · DETAILED RATI ONALES
,NUR 231 Maternal Nursing - Exam 4 Practice Examination 2026 Edition
NUR 231 Maternal Nursing
Exam 4 Practice Examination - 70 Questions with Answers and Detailed Rationales
Original NCLEX-style study companion aligned with labor and birth, obstetric emergencies, postpartum, and newborn care
content areas
Directions: Choose the single best answer for each multiple-choice question. For items marked Select all
that apply, choose every option that is correct. Prioritization items ask you to identify which client to assess
first or which action to take first. The correct answer and a detailed rationale - including why each incorrect
option is wrong - appear directly below every question, so the exam doubles as a self-paced review.
1. A nurse is evaluating a client at 38 weeks of gestation who reports regular
uterine contractions for the past 4 hours. Which assessment finding best
distinguishes true labor from false labor?
A. Contractions decrease in intensity when the client rests and drinks fluids
B. Progressive cervical effacement and dilation are documented on examination
C. The discomfort is felt primarily in the front of the abdomen
D. The client is still able to feel fetal movement during contractions
CORRECT ANSWER: B
Rationale. Correct: B. Progressive cervical change (effacement and dilation) is the single definitive sign of
true labor; only true labor produces measurable cervical change over time. Option A describes false
(Braxton Hicks) labor, which characteristically eases with rest, hydration, and position change. Option C is
unreliable because early true labor often begins with low back discomfort that radiates to the abdomen,
while false labor is typically felt in the front of the abdomen only. Option D is not diagnostic because fetal
movement continues in both true and false labor.
2. A laboring client at 8 cm dilation becomes irritable, states she feels like she
needs to have a bowel movement, and screams that she cannot continue. The
nurse recognizes these findings as characteristic of which phase of labor?
A. Latent phase of the first stage
B. Active phase of the first stage
C. Transition phase of the first stage
D. Early latent period of the second stage
1
,NUR 231 Maternal Nursing - Exam 4 Practice Examination 2026 Edition
CORRECT ANSWER: C
Rationale. Correct: C. The transition phase (approximately 8 to 10 cm) produces intense contractions
every 2 to 3 minutes, irritability, loss of control, rectal pressure from descending presenting part, nausea,
and the urge to bear down. Option A is incorrect because the latent phase produces mild, irregular
contractions and a talkative, excited client. Option B is incorrect because during the active phase the client
is usually more focused and still coping, with contractions of moderate intensity. Option D is incorrect
because the second stage begins at complete dilation (10 cm); this client is at 8 cm and remains in the first
stage.
3. The nurse is reviewing continuous fetal monitoring strips on the labor and
birth unit. Which finding requires no further intervention because it is a normal
category I (reassuring) pattern?
A. Baseline fetal heart rate of 96 beats per minute
B. Baseline fetal heart rate of 150 beats per minute with accelerations
C. Baseline fetal heart rate of 172 beats per minute
D. Baseline fetal heart rate of 104 beats per minute with recurrent variable
decelerations
CORRECT ANSWER: B
Rationale. Correct: B. A normal fetal heart baseline ranges from 110 to 160 beats per minute, and
spontaneous accelerations indicate fetal well-being and an intact neurologic response, so this tracing is
reassuring and requires only routine monitoring. Option A describes fetal bradycardia (below 110), which
warrants immediate assessment for hypoxia, cord problems, or medications. Option C describes fetal
tachycardia (above 160), which suggests fever, dehydration, hypoxia, or medication effects. Option D
combines bradycardia with recurrent variable decelerations, a pattern strongly associated with cord
compression and fetal hypoxia that requires intervention.
4. A client receiving an oxytocin infusion for labor augmentation develops
recurrent late decelerations on the fetal monitor. Which action should the
nurse take first?
A. Increase the oxytocin rate to strengthen contractions
B. Discontinue the oxytocin infusion
C. Reposition the client supine with legs elevated
D. Prepare for an immediate amnioinfusion
2
, NUR 231 Maternal Nursing - Exam 4 Practice Examination 2026 Edition
CORRECT ANSWER: B
Rationale. Correct: B. Late decelerations indicate uteroplacental insufficiency; when oxytocin is infusing,
the first priority is to stop the infusion because oxytocin-induced hyperstimulation reduces placental
perfusion between contractions. Option A would worsen uteroplacental insufficiency and further
compromise the fetus. Option C is incorrect because the supine position compresses the vena cava and
worsens perfusion; the nurse should place the client in a lateral position, not supine. Option D is incorrect
because amnioinfusion is the treatment for recurrent variable decelerations caused by cord compression, not
late decelerations.
5. During labor, a client develops severe variable decelerations that persist
after the nurse repositions her and applies an oxygen mask. Which
intervention should the nurse anticipate next?
A. Amnioinfusion of warmed isotonic fluid through an intrauterine catheter
B. Immediate discontinuation of all IV fluids
C. Application of a fetal scalp electrode
D. Administration of a tocolytic to stop all contractions
CORRECT ANSWER: A
Rationale. Correct: A. Variable decelerations are caused by umbilical cord compression, and when
conservative measures (position change, oxygen, IV fluid increase) fail, amnioinfusion cushions the cord
and relieves recurrent variable decelerations. Option B is incorrect because hydration supports placental
perfusion; stopping IV fluids would not relieve cord compression. Option C is incorrect because a scalp
electrode monitors the tracing more precisely but does nothing to correct the compression causing the
decelerations. Option D is incorrect because tocolytics are reserved for specific hypoxic patterns such as
tachysystole with prolonged decelerations, and they are not the anticipated next step for persistent variables.
6. A laboring client at 8 cm dilation has early decelerations of the fetal heart rate
that mirror her contractions. The baseline heart rate is 140 beats per minute with
moderate variability. Which nursing action is appropriate?
A. Notify the provider immediately and prepare for cesarean birth
B. Document the finding and continue routine monitoring
C. Reposition the client and begin an amnioinfusion
D. Discontinue the oxytocin infusion and administer oxygen
3
Maternal Nursing
Exam 4 2026\2027
update
Seventy NCLEX-style questions covering
labor and birth, obstetric emergencies, the
postpartum period, and newborn adaptation —
each with the correct answer and a detailed
rationale explaining every distractor.
Galen Maternal-Newborn Nursing Curriculum
Alignment
70 QUESTIONS · ANSWERS · DETAILED RATI ONALES
,NUR 231 Maternal Nursing - Exam 4 Practice Examination 2026 Edition
NUR 231 Maternal Nursing
Exam 4 Practice Examination - 70 Questions with Answers and Detailed Rationales
Original NCLEX-style study companion aligned with labor and birth, obstetric emergencies, postpartum, and newborn care
content areas
Directions: Choose the single best answer for each multiple-choice question. For items marked Select all
that apply, choose every option that is correct. Prioritization items ask you to identify which client to assess
first or which action to take first. The correct answer and a detailed rationale - including why each incorrect
option is wrong - appear directly below every question, so the exam doubles as a self-paced review.
1. A nurse is evaluating a client at 38 weeks of gestation who reports regular
uterine contractions for the past 4 hours. Which assessment finding best
distinguishes true labor from false labor?
A. Contractions decrease in intensity when the client rests and drinks fluids
B. Progressive cervical effacement and dilation are documented on examination
C. The discomfort is felt primarily in the front of the abdomen
D. The client is still able to feel fetal movement during contractions
CORRECT ANSWER: B
Rationale. Correct: B. Progressive cervical change (effacement and dilation) is the single definitive sign of
true labor; only true labor produces measurable cervical change over time. Option A describes false
(Braxton Hicks) labor, which characteristically eases with rest, hydration, and position change. Option C is
unreliable because early true labor often begins with low back discomfort that radiates to the abdomen,
while false labor is typically felt in the front of the abdomen only. Option D is not diagnostic because fetal
movement continues in both true and false labor.
2. A laboring client at 8 cm dilation becomes irritable, states she feels like she
needs to have a bowel movement, and screams that she cannot continue. The
nurse recognizes these findings as characteristic of which phase of labor?
A. Latent phase of the first stage
B. Active phase of the first stage
C. Transition phase of the first stage
D. Early latent period of the second stage
1
,NUR 231 Maternal Nursing - Exam 4 Practice Examination 2026 Edition
CORRECT ANSWER: C
Rationale. Correct: C. The transition phase (approximately 8 to 10 cm) produces intense contractions
every 2 to 3 minutes, irritability, loss of control, rectal pressure from descending presenting part, nausea,
and the urge to bear down. Option A is incorrect because the latent phase produces mild, irregular
contractions and a talkative, excited client. Option B is incorrect because during the active phase the client
is usually more focused and still coping, with contractions of moderate intensity. Option D is incorrect
because the second stage begins at complete dilation (10 cm); this client is at 8 cm and remains in the first
stage.
3. The nurse is reviewing continuous fetal monitoring strips on the labor and
birth unit. Which finding requires no further intervention because it is a normal
category I (reassuring) pattern?
A. Baseline fetal heart rate of 96 beats per minute
B. Baseline fetal heart rate of 150 beats per minute with accelerations
C. Baseline fetal heart rate of 172 beats per minute
D. Baseline fetal heart rate of 104 beats per minute with recurrent variable
decelerations
CORRECT ANSWER: B
Rationale. Correct: B. A normal fetal heart baseline ranges from 110 to 160 beats per minute, and
spontaneous accelerations indicate fetal well-being and an intact neurologic response, so this tracing is
reassuring and requires only routine monitoring. Option A describes fetal bradycardia (below 110), which
warrants immediate assessment for hypoxia, cord problems, or medications. Option C describes fetal
tachycardia (above 160), which suggests fever, dehydration, hypoxia, or medication effects. Option D
combines bradycardia with recurrent variable decelerations, a pattern strongly associated with cord
compression and fetal hypoxia that requires intervention.
4. A client receiving an oxytocin infusion for labor augmentation develops
recurrent late decelerations on the fetal monitor. Which action should the
nurse take first?
A. Increase the oxytocin rate to strengthen contractions
B. Discontinue the oxytocin infusion
C. Reposition the client supine with legs elevated
D. Prepare for an immediate amnioinfusion
2
, NUR 231 Maternal Nursing - Exam 4 Practice Examination 2026 Edition
CORRECT ANSWER: B
Rationale. Correct: B. Late decelerations indicate uteroplacental insufficiency; when oxytocin is infusing,
the first priority is to stop the infusion because oxytocin-induced hyperstimulation reduces placental
perfusion between contractions. Option A would worsen uteroplacental insufficiency and further
compromise the fetus. Option C is incorrect because the supine position compresses the vena cava and
worsens perfusion; the nurse should place the client in a lateral position, not supine. Option D is incorrect
because amnioinfusion is the treatment for recurrent variable decelerations caused by cord compression, not
late decelerations.
5. During labor, a client develops severe variable decelerations that persist
after the nurse repositions her and applies an oxygen mask. Which
intervention should the nurse anticipate next?
A. Amnioinfusion of warmed isotonic fluid through an intrauterine catheter
B. Immediate discontinuation of all IV fluids
C. Application of a fetal scalp electrode
D. Administration of a tocolytic to stop all contractions
CORRECT ANSWER: A
Rationale. Correct: A. Variable decelerations are caused by umbilical cord compression, and when
conservative measures (position change, oxygen, IV fluid increase) fail, amnioinfusion cushions the cord
and relieves recurrent variable decelerations. Option B is incorrect because hydration supports placental
perfusion; stopping IV fluids would not relieve cord compression. Option C is incorrect because a scalp
electrode monitors the tracing more precisely but does nothing to correct the compression causing the
decelerations. Option D is incorrect because tocolytics are reserved for specific hypoxic patterns such as
tachysystole with prolonged decelerations, and they are not the anticipated next step for persistent variables.
6. A laboring client at 8 cm dilation has early decelerations of the fetal heart rate
that mirror her contractions. The baseline heart rate is 140 beats per minute with
moderate variability. Which nursing action is appropriate?
A. Notify the provider immediately and prepare for cesarean birth
B. Document the finding and continue routine monitoring
C. Reposition the client and begin an amnioinfusion
D. Discontinue the oxytocin infusion and administer oxygen
3
